# The clinical trial activation process: a case study of an Italian public hospital

## TL;DR

This paper describes how a hospital in Italy improved the speed of starting clinical trials by reorganizing its processes and training staff.

## Contribution

The study presents a reorganization project using Lean Thinking to significantly reduce clinical trial activation times in a public hospital.

## Key findings

- The mean trial activation time was reduced from 218 days to 56 days after the reorganization project.
- Each facility involved in the process halved its average time for trial activation activities.
- A standard operating procedure and monitoring tool were developed for broader implementation.

## Abstract

In order to make the centers more attractive to trial sponsors, in recent years, some research institutions around the world have pursued projects to reorganize the pathway of trial activation, developing new organizational models to improve the activation process and reduce its times.

This study aims at analyzing and reorganizing the start-up phase of trials conducted at the Research and Innovation Department (DAIRI) of the Public Hospital of Alessandria (Italy).

A project was carried out to reorganize the trial authorization process at DAIRI by involving the three facilities responsible for this pathway: clinical trial center (CTC), ethics committee secretariat (ESC), and administrative coordination (AC).

Lean Thinking methodology was used with the A3 report tool, and the analysis was carried out by monitoring specific key performance indicators, derived from variables representing highlights of the trials’ activation pathway.

The project involved phases of analysis, implementation of identified countermeasures, and monitoring of timelines in eight 4-month periods.

The overall mean and median values of studies activation times were calculated as well as the average times for each facility involved in the process.

In this study, 298 studies both sponsored by research associations and industry with both observational and interventional study design were monitored.

The mean trial activation time was reduced from 218 days before the project to 56 days in the last period monitored.

From the first to the last monitoring period, each facility involved achieved at least a halving of the average time required to carry out its activities in the clinical trials’ activation pathway (CTC: 55 days vs 23, ECS: 25 days vs 8, AC 29 days vs 10).

Average activation time for studies with agreement remains longer than those without agreement (100 days vs. 46).

The reorganization project emphasized the importance of having clinical and administrative staff specifically trained on the trial activation process.

This reorganization led to the development of a standard operating procedure and a tool to monitor the time (KPIs of the process) that can also be implemented in other clinical centers.

The online version contains supplementary material available at 10.1186/s13063-024-08059-z.